CVD - ANGINA

Question 1

GTN is normally used for acute attacks, how would you take it?

Answer 1

When required or before angina induced activities

Question 2

When would you need to consider switching to long term prophylaxis when using GTN spray?

Answer 2

If using it more than twice a week

Question 3

How soon after opening to GTN sublingual tablets expire?

Answer 3

8 weeks

Question 4

What are the guidelines for angina prophylaxis?

Answer 4

1) Beta blocker or rate limiting CCB (diltiazem or verapamil)
2) Beta blocker + dihydropyridine CCB - if one is contraindicated use a vasodilator (long acting nitrate, ivabradine, ranolazine, nicorandil

Question 5

What are examples of long acting nitrates used in long term prophylaxis?

Answer 5

MR isosorbide dinitrate BD

Isosorbide mononitrate BD

Question 6

When can tolerance develop?

Answer 6

When you use transdermal patches that contain nitrates

Question 7

What would you do if tolerance was suspected?

Answer 7

Leave patch off for 8-12 hours

Take second dose after 8 hours and not 12 hours

Nitrates will finish 4 hours earlier so you have 4 hours of nitrate free blood at the end of the day

Question 8

What are the side effects of nitrates?

Answer 8

Throbbing headache, dizziness, flushing, postural hypotension - all due to vasodilation

With the injection you can get severe hypotension, sweating, restlessness, muscle twitching

Abrupt withdrawal of nitrates and CCBs can worsen angina